Geriatric Rehabilitation Manual.

Geriatric Rehabilitation Manual Kauffman TL, ed. Philadelphia, PA 19106, Churchill Livingstone Inc, 1999, paperback, 459 pp, illus, ISBN: 0-443-02651-0, $49.95.

Clinicians who care for geriatric patients will welcome this text as a resource for background information, diagnostic procedures, and potential interventions in the treatment of diseases and disabilities of elderly people. Although it is focused on the entire rehabilitation team, this book is clearly targeted to physical therapists. The editor has gathered well-researched chapters from a large group of well-known contributors, which in itself imparts some intrinsic value to the book.

The text contains 82 chapters organized into 7 separate units. The first unit deals with general physiological considerations for working with the geriatric patient. The different body systems are reviewed, and the effects of aging are discussed. Also, a new paradigm is presented that focuses on concepts of wholeness and uniqueness versus the traditional medical model. Although it is a small portion of chapter 1, this idea could well be carried throughout the first 2 units.

Chapters 14 through 54 comprise the second unit and focus on pathokinesiological manifestations and therapeutic intervention. This particular unit does incorporate more relevant clinical information and applications than do similar geriatric texts. The second unit has a comprehensive approach to the muscular, orthopedic, and neurological conditions seen in rehabilitation. I question whether multiple sclerosis can be considered a disease of the elderly, although patients with multiple sclerosis certainly do age and have intervention considerations that are worthy of investigation.

The third unit is comparatively short with only 3 chapters that deal with vision, hearing, and communication. The brevity of this section further helps focus the text on the physical therapist. Unit 4 is unique to a text of this type and is a worthy unit for any clinician to review. It covers an array of common medical issues of the elderly, including dysphagia, incontinence, immobility, estrogen replacement, dizziness, balance, stiffness, and pain. The inset boxes, figures, and tables further clarify the discussions and allow for a quick view of each section.

Specific physical therapy interventions are discussed in unit 5. The 5 chapters provide data relevant to the very core of physical therapy interventions for the elderly, including gait training, modalities, and orthotics and prosthetics. These chapters provide an excellent overview for the experienced clinician in addition to describing appropriate treatment approaches and applications for the less experienced therapist.

Unit 6 deftly covers the ethics of death and dying. This unit is exceptionally well written with a clear focus on the elderly patient. The discussions are based in current health care situations and are grounded in reality. This section also covers health policy discussions and funding considerations.

The final unit, unit 7, discusses the rehabilitation team in 6 chapters. These concluding chapters remind the reader that teamwork is actually a dynamic process that involves different care providers, policy concerns, the facility, and family members and is focused on the individual, unique, elderly patient.

The single drawback to this work is its layout. The pages are displayed in 2 columns, and chapters end on the same page that the next chapter begins. This lack of white space and run-on of chapters does distract the reader from the information. Perhaps the sheer volume of information necessitated this particular format.

Geriatric Rehabilitation Manual is a seminal work in the field of geriatric rehabilitation. Its contributors include many well-known and previously published therapists. Along with the basic and theoretical coverage of geriatric pathologies, the book further delves into issues--with in-depth discussions of ethics, death and dying, and the rehabilitation team--that are not included in similar texts. This text is a thorough, comprehensive book that is appropriate as a working reference text for clinicians and as a required textbook for physical therapist students.

Cheryl LaFollette Anderson, PT, PhD, GCS Alexandria, Minn

Dr Anderson is a clinician, researcher, consultant, and educator in rural Minnesota.